Tx-Related AML Not as Deadly If Tx Was Taxane

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Women with breast cancer who developed treatment-related acute myeloid leukemia (AML) had an overall survival similar to those with de novo AML only if they had received taxane therapy, a study found.

Note that the study was retrospective and small but was initiated with the concern that patients receiving taxanes might have a poorer outcome with treatment-related AML.

ATLANTA – Cancer therapy-related acute myeloid leukemia (AML) has a poor prognosis, but in breast cancer patients who had been treated with taxanes, overall survival of the therapy-related cancer was similar to that seen in women treated for de novo AML, researchers suggested here.

In a retrospective study, patients who were treated with taxanes and developed treatment-related AML achieved about a 6-year overall survival of about 20%, compared with about a 25% 6-year overall survival for individuals who were diagnosed with de novo AML (P=0.479), said lead author Lindsey Roeker, BS, a medical student at the Mayo College of Medicine in Rochester, Minn.

Overall, patients with treatment-related AML had about a 10% overall survival at 6 years (P=.0414), a statistically significantly worse outcome compared with women diagnosed with de novo AML, she said at the annual meeting of the American Society of Hematology. All patients with treatment-related AML who did not receive taxanes died within about 2 years of being diagnosed with the leukemia, Roeker told MedPage Today at her poster presentation.

Median survival was 584 days for patients with de novo AML and 375 days for the women who were treated with taxanes for their breast cancer. For women not treated with taxanes the median overall survival was 222 days (P< 0.001), she reported.

In the 21-year retrospective look at records from Mayo, Roeker and her research team were able to identify 23 women who developed treatment-related AML after they had undergone standard therapy for breast cancer. She said that 14 of the women had undergone taxane treatment and nine women had not. Their outcomes were compared with the 65 women treated at Mayo for de novo AML.

"We realize that the number of patients in our study is small," Roeker said, "so we were a little surprised that the differences we saw achieved statistical significance."

The outcomes were somewhat surprising as well, she said, because researchers had thought that taxane therapy might be more of a problem for the patients rather than possibly being protective.

"Taxane therapy has become essential in the management of breast cancer in light of its favorable effect on survival in short-term studies," Roeker reported in her presentation. "However, clinical trials fail to capture acute leukemias related to recently introduced agents, since development of treatment-related AML occurs years after chemotherapy."

The chart review evaluated outcomes in patients diagnosed with AML at Mayo Clinic between 1990 and 2011. Patients were included if they had previously received chemotherapy for breast cancer, or if they had never received any chemotherapy. Demographic data, previous diagnosis and treatment regimen, blood work at diagnosis, pathology and cytogenetic information, therapy used, and response were collected for each patient.

Eyal Attar, MD, attending physician at Massachusetts General Hospital, told MedPage Today, "These findings in this retrospective analysis are interesting. I think we have to consider the results as very preliminary. We need to know more about the genetics of the leukemia to get a good picture of why or how the use of taxanes may be affecting survival in these patients."

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